Your Guide to Understanding Qualifying Life Events and Special Enrollment Periods

The Affordable Care Act, popularly known as “Obamacare,” changed a lot when it comes to health insurance, including when you can sign up for it.

Before the ACA, if you wanted or needed health insurance your employer didn’t offer, you could apply to a private insurer any time of year and be offered a policy priced according to your gender, age and health history. Now that insurers can’t price policies based on those personal details, and everyone has to have health insurance or pay a penalty, open enrollment is the only time you can apply for a compliant plan - unless your life changes in a big way.

Without an open enrollment period, insurers face what’s called a moral hazard: Because the tax penalty is cheaper than a year’s worth of insurance premiums, healthy people could plan to pay it and get an insurance policy only when they need one. “There’s a very strong incentive for people to only sign up when they’re sick, and that makes rates go through the roof,” explains Shana Charles, health policy expert and assistant professor at California State University in Fullerton.

Learn more about open enrollment, when yours is, and whether you may be able to get insurance outside of that window.

When is open enrollment?

• Federal and state ACA exchanges: Nov. 1, 2016–Jan. 31, 2017.
• Medicare: Oct. 15–Dec. 7, 2016.
• Medicaid: no open enrollment; you can join or cancel Medicaid year-round.
• Children’s Health Insurance Plans: no open enrollment; you can join or cancel CHIP year-round.

Special enrollment periods

• Marriage, divorce or legal separation.
• Adoption or birth of a child.
• Death of a spouse or child.
• A child on your policy turns 26.
• Taking or returning from a leave of absence.
• A change in your work schedule that causes you to gain or lose coverage.
• Change in residence or work location of you or a dependent on the policy.
• Losing job-based coverage, either through your employer or a family member’s.
• Losing individual health coverage through a private plan.
• Losing eligibility for Medicare, Medicaid or CHIP.
• You or one of your covered dependents gain or lose other benefits coverage due to a change in employment status — for example, beginning or ending a job.
• Changes in your income that affect the coverage you qualify for.
• Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder.
• Becoming a U.S. citizen.
• Leaving jail or prison.
• AmeriCorps members starting or ending their service.

Missed open enrollment and don’t have a qualifying life event?

Open enrollment is the period each year when you can sign up for health insurance, change your existing health plan or cancel coverage. During open enrollment, you have plenty of decisions to make, so consult this guide to make sure you’re shopping smart when the time comes.

Open enrollment usually occurs near the end of a calendar year, and the coverage you sign up for usually starts on Jan. 1 of the next year, though the exact time frame will depend on who provides your health insurance.

For public health plans in 2017, open enrollment periods are:

If you get health insurance through an employer, your open enrollment period will likely be much shorter and determined by your company. You can check with a human resources representative to find out when it is, but just like the public programs listed above, your company may have certain exceptions.

Life happens, and when it does, your health coverage may have to change. If you experience a qualifying life event that affects your insurance needs, you can take advantage of a special enrollment period.

If you have insurance through your job, your company’s human resources department should work with you to update your plan if you experience a qualifying life event. Your company may only allow 30 days to change your plan, so don’t wait to inform HR if you experience the following and need to change your coverage:

To add, change or discontinue health insurance outside of open enrollment in a public health plan, the same life events apply, plus a few more. These also count as qualifying life events for existing or potential Medicare and ACA plan beneficiaries:

If you have an ACA plan and one of these events occurs, you’ll likely have 60 days from the time of the event to secure new health insurance or update your policy without facing the tax penalty. There are other, more complicated life events that may qualify you for special enrollment in public programs, and those are considered on a case-by-case basis. You’ll have to apply here to know for sure.